Abstract：
OBJECTIVE: In recent years, the trauma mechanisms and fracture types in tibial plateau fractures (TPF) have changed. At the same time, treatment strategies have expanded with the establishment of new classification systems, extension of diagnostics and surgical strategies. Evidence-based recommendations for treatment strategies are rare. The aim of this study is to assess the extent of standardization in the treatment of complex TPF.
METHODS: For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed.
RESULTS: A total of 23 surgeons from 7 hospitals (Trauma center levels I-III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2%, II: 56.5%, III: 60%). Averaged over all three fractures, 55% of the respondents chose the same patient positioning. The combination of a posteromedial and anterolateral approach was the most frequently chosen approach at 42.7%. Double plating was favored for the surgical treatment of all fractures (70.7%). Preoperative MRI, extended approaches and intraoperative fraturoscopy were significantly more common in level I trauma centres.
CONCLUSIONS: There are major differences in the management of complex TPF. 360° treatment is carried out in all departments regardless of the level of care, but without further standardization in terms of preoperative imaging, classification, initial treatment, approach, fixation and intraoperative imaging. There are major differences within the departments with different level of care.
METHODS: For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed.
RESULTS: A total of 23 surgeons from 7 hospitals (Trauma center levels I-III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2%, II: 56.5%, III: 60%). Averaged over all three fractures, 55% of the respondents chose the same patient positioning. The combination of a posteromedial and anterolateral approach was the most frequently chosen approach at 42.7%. Double plating was favored for the surgical treatment of all fractures (70.7%). Preoperative MRI, extended approaches and intraoperative fraturoscopy were significantly more common in level I trauma centres.
CONCLUSIONS: There are major differences in the management of complex TPF. 360° treatment is carried out in all departments regardless of the level of care, but without further standardization in terms of preoperative imaging, classification, initial treatment, approach, fixation and intraoperative imaging. There are major differences within the departments with different level of care.
摘要：
目的：近年来，胫骨平台骨折（TPF）的创伤机制和骨折类型发生了变化。同时,随着新分类系统的建立，治疗策略已经扩展，诊断和手术策略的扩展。基于证据的治疗策略建议很少。这项研究的目的是评估复杂TPF治疗的标准化程度。
方法：对于研究，向创伤外科/骨科专家介绍了三个复杂TPF的薄层CT数据集，包括3D重建。然后完成关于骨折形态和计划治疗策略的标准化问卷。
结果：共包括来自7家医院（创伤中心I-III级）的23名外科医生。所有三种骨折最常被归类为SchatzkerV型（骨折I：52.2％，II:56.5%,III：60%）。平均三个骨折，55%的受访者选择了同一患者定位。后内侧和前外侧入路的组合是最常选择的入路，占42.7％。双钢板对于所有骨折的手术治疗都是有利的(70.7%)。术前MRI,在I级创伤中心,扩展入路和术中镜架镜检查更为常见.
结论：复杂TPF的管理存在主要差异。无论护理水平如何，所有部门都进行360°治疗，但是在术前成像方面没有进一步的标准化，分类，初始治疗,方法，固定和术中成像。不同护理水平的部门内部存在重大差异。
方法：对于研究，向创伤外科/骨科专家介绍了三个复杂TPF的薄层CT数据集，包括3D重建。然后完成关于骨折形态和计划治疗策略的标准化问卷。
结果：共包括来自7家医院（创伤中心I-III级）的23名外科医生。所有三种骨折最常被归类为SchatzkerV型（骨折I：52.2％，II:56.5%,III：60%）。平均三个骨折，55%的受访者选择了同一患者定位。后内侧和前外侧入路的组合是最常选择的入路，占42.7％。双钢板对于所有骨折的手术治疗都是有利的(70.7%)。术前MRI,在I级创伤中心,扩展入路和术中镜架镜检查更为常见.
结论：复杂TPF的管理存在主要差异。无论护理水平如何，所有部门都进行360°治疗，但是在术前成像方面没有进一步的标准化，分类，初始治疗,方法，固定和术中成像。不同护理水平的部门内部存在重大差异。
